Individual
ANGEL LUIS PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1001 BLYTHE BLVD STE 300, CHARLOTTE, NC 28203-5863
(704) 373-0212
(704) 372-1249
Mailing address
PO BOX 60122, CHARLOTTE, NC 28260-0122
(704) 373-0212
(704) 372-1249
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
101693
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0195PA
—
SC
Enumeration date
08/20/2006
Last updated
06/04/2012
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